Individual Plan (ACA)

The Affordable Care Act (ACA) provides a framework for individuals seeking health insurance coverage. An individual health insurance plan under the ACA is designed for those who do not qualify for Medicare and are under 65 years of age. These plans are available through state-based exchanges and the Health Insurance Marketplace.

Key features of ACA individual plans include:

• Essential Health Benefits: All ACA-compliant plans must cover ten essential health benefits, including emergency services, hospitalization, maternity and newborn care, mental health services, and preventive services.

• No Denial for Pre-existing Conditions: Insurers cannot deny coverage or charge higher premiums based on pre-existing health conditions.

• Subsidies and Cost-Sharing Reductions: Depending on your income, you may qualify for financial assistance to help lower your monthly premiums and out-of-pocket costs.

• Open Enrollment Period: Individual ACA plans have specific open enrollment periods during which you can apply, renew, or change your coverage. Outside of this period, you may qualify for a Special Enrollment Period due to life events such as marriage, birth, or loss of other coverage.

• Network Providers: Many individual plans have a network of doctors and hospitals. It's important to review whether your preferred providers are in-network to reduce your costs.

Choosing an individual ACA plan involves evaluating your healthcare needs, budget, and the coverage options available in your area. It’s advisable to explore multiple plans to find one that best fits your circumstances.

• Who Qualifies for ACA Plans?

  • U.S. citizens and legal residents who do not qualify for Medicare.

  • Individuals who do not have employer-sponsored insurance or government programs like Medicaid.

  • People under 65 with pre-existing conditions (insurers cannot deny coverage).

  • Those who want to compare private health plans and apply for subsidies (financial help)

  For personalized guidance about ACA Plans, contact our licensed agent now!, NY, CT STATE